Vance C. Smith, Jr., Commissioner DEPARTMENT OF TRANSPORTATION
One Georgia Center, 600 West Peachtree Street, NW
Atlanta, Georgia 30308
Telephone: (404) 631-1000
Thank you for your interest in becoming a registered subcontractor to perform work on subcontracts with the Georgia
Department of Transportation. You must complete and submit the following to become a registered subcontractor.
DOT FORM 478 QUESTIONNAIRE
REFERENCE LETTERS PAST JOB PERFORMANCE
If you have not performed work for this Department in the last five (5) years, you must submit three (3) reference letters from
three (3) agencies or individuals you have completed work for in the past three (3) years. We are interested in the type of work
performed, the quality of your services, whether the work was completed within the time allowed and the level of cooperation
provided in completing the project. Address reference letters to: Mr. Gregory T. Mayo, Chairman, Prequalification
Committee Contractors and mail to the address in the closing paragraph.
To avoid a delay in processing your request, return the entire application and answer each question. If the question does not
apply, “NA” or “None Applicable” is an acceptable response. Failure to return each page or answer any portion of the
application is considered an omission resulting in a non-compliant request. INCOMPLETE APPLICATIONS WILL BE
Before submitting your request, refer to the checklist included with this package to make sure the application is complete and
accurate. Return one original DOT Form 478 and three reference letters (if necessary) to the Georgia Department of
Transportation, Office of Transportation Services – Contractor Prequalification, Attn: Doris Osby, 600 West Peachtree Street,
NW, 19th Floor, Atlanta, GA 30308. Please contact Doris Osby @ 404-631-1213 should you have any questions. Again, thank
you for your interest in Georgia’s bidding process and allowing us the opportunity to serve you.
Gregory T. Mayo, PE
Attachment (Checklist & DOT Form 478)
QUESTIONNAIRE — DOT FORM 478
GENERAL INFORMATION — PAGE 1
Provide the company’s full name, the complete mailing address, the IRS number and check the type of business entity. If
you are a corporation, the name on the application must correspond with the name imprinted on your corporate
seal. Provide an explanation for any discrepancy in the company name on letterhead and submit the letter with the
ELECTRICAL CONTRACTORS ONLY — PAGE 3
Applicants seeking prequalification as an electrical contractor must provide the organization’s name and the electrician’s
name, license number and year(s) of experience in roadway, sign or navigational lighting.
CHRONOLOGICAL HISTORY AND MANAGEMENT STRUCTURE — PAGE 4 & 5
Provide the name and experience of all officers, supervisors and field personnel. Address ALL concerns stated on page five
with a “YES,” “NO” or “NA” response.
PAST JOB PERFORMANCE — PAGE 6
Provide the name of the contracting agency, the location and type of work performed and the contract amount.
Subcontractors must give the name of the prime contractor. Answer “YES” or “NO” to the questions in columns (E), (F) &
(G) and explain the details in connection with all none or untimely completion of projects on page 10, item (12A).
FIXED ASSETS — PAGE 7, 8 & 9
Itemize and state the age, cost, depreciation charge-off and the book value (cost less depreciation) of each item. Provide a
summary according to the category/type of all fixed assets including your ―Land and Building‖ on the appropriate page.
(See page three of DOT Form 477, lines I (1a thru d) and I(2a thru c) for asset categories. Sub and grand totals must be
stated at book value. If additional space is required to itemize your equipment, you may attach additional pages provided
you follow the format of the schedules on pages seven and eight of DOT Form 478. Transfer your grand total to the
TOTAL$ line at the bottom of page seven and/or eight of DOT Form 478. If you do not own equipment, submit a “Lease
Agreement” or an itemized schedule of the items available to you from the leasing agent on page nine.
CLAIMS, LIQUIDATED DAMAGES, INSURANCE, ANTI-TRUST VIOLATIONS AND COLLUSION
PAGE 10 & 11
Complete (12A) & B) if applicable. An authorized officer of the company must sign and provide his/her official title.
ENTITY, OFFICERS AND CORPORATE AND NOTARY SEALS — PAGE 12
All applicants must complete this page according to the entity’s type and structure. Provide the name and title of all personnel
authorized to sign/withdraw contract documents from the Department on behalf of the company. This page must be signed by an
authorized officer and notarized by a notary public. Corporations must affix the corporate seal.
If you have not complete work for this agency in the last five years, submit three reference letters from agencies or individuals
you have completed work for in the past three years. The letter must be on company letterhead. We do not accept references via
Email unless they are on electronically formatted or scanned letterhead.